What to Expect in Eating Disorder Counseling Part 2: Changing Old Habits and Behaviors

In Part 1 of this series, we reviewed the basics of the beginning phase of eating disorder therapy. Here I delve into the next phase: how do we actually change what we do on a daily basis and create new patterns and habits?

Eating disorder behaviors and habits are triggered by various factors, and in therapy we will help you uncover this. Once you have some practice identifying what led to the problem behavior and habits, you can then begin the difficult (but ultimately very rewarding!) work of making deep change. This can be daunting, especially if you have a long history with your eating problem, but your therapist and other treatment team members will walk alongside you as you progress.  

Motivation and goal setting

How motivated are you for changing your relationship with food and your body? This question is central to the work you will do in therapy. Motivation changes throughout treatment for eating disorders, and this impacts the goals we set. You will likely feel uncertain about your progress along the way. 

Therapists want to hear your thoughts and feelings about entering treatment. Maybe you are in our office because a family member urged you to get help, or perhaps because you have finally gotten tired of hating your body every day. 

We listen to your worries about changing your relationship with food. Maybe you feel overwhelming anxiety about giving up your "clean eating" habit because you believe it's healthy. But, you know something needs to change since you are now underweight or you fear leaving the safety of your home to eat.

We help you explore your feelings about your body and the possibility that it might change. For some this may involve exploring how their intense body shame is rooted in teasing they experienced as a child. For most, the predominant feeling uncovered is the fear of gaining weight. 

Letting go of old behaviors is hard, especially those that are rewarding in some ways. Your team works to find ways to motivate you along the way and to set goals that fit with where you are. We work to uncover what keeps the eating problem going for you and we set goals to address this.

Support of family and friends

Your family and friends may feel left out and unsure of how to help. Part of therapy may involve finding ways to include them and teach them how to support you, if you so desire. You may also want to work on improving communication and setting healthy boundaries with loved ones. Eating disorder therapists are skilled in addressing this, too. 

Medical and nutritional stabilization

Do your behaviors include restricting calories, self-induced vomiting, overexercise, or a combination of these? If so, your eating disorder behaviors are putting your health at risk.

Early on, therapy will focus on helping you become stable, to stop the damage you may be doing to your body. This may require a referral to a more intense program than outpatient therapy so that nutritional and medical concerns can be monitored more closely. Nutritional instability results in a brain and body that cannot function at their best, making other aspects of therapy too challenging. We include other professionals in this endeavor if necessary, including Registered Dietitians and Medical Doctors. We collaborate with one another to help you recover.

Getting to know your thoughts

Do you have rigid dietary rules for yourself? Have your weight and body size/shape become the focus of your life? Is much of your time spent thinking about controlling your weight and body? Do thoughts about yourself focus mostly on your weight and body? Do you believe you won't ever succeed at recovering from an eating disorder, or that you don't deserve to recover?

This is the thinking that keeps you locked in an eating disorder. In therapy, we will work to identify the kind of thinking that triggers and maintains eating and body image problems. We guide you in becoming an expert at this! You will learn how to identify these thoughts, known as cognitive distortions, irrational thoughts, thinking errors, and narratives. We then teach you to challenge the thoughts and reframe them into more rational, helpful thoughts. Sometimes it's not possible or easy to change the thinking, and then we focus instead on helping you accept the thoughts and learn to tolerate them a little more. 

Getting to know your feelings

One of the cornerstones of recovery from an eating disorder (as well as many other mental health problems) is a thorough exploration of emotions. We will examine how you typically express them and how you have used eating disorder behaviors to avoid uncomfortable feelings.

We then work on strengthening your ability to feel and express emotions in a healthy manner. I like to think of this as wonderful life skills training, as being able to to identify and express emotions in a healthy way is a vital skill in so many areas of our lives. We don't usually learn how to do this in school as kids, and sometimes not even in our childhood homes. Therapy can be a safe place to learn this valuable skill. 

In Part 3 of this series, What to Expect in Eating Disorder Counseling, I will dive deeper into the work of the later stages of therapy for eating disorders. 


If you are looking for eating disorder treatment in Plano, Texas or Frisco, Texas, or just want to make peace with your body, give me a call at 469-850-2420 for a free 15 minute phone consultation. My name is Danesa, and we can see if we're a good fit! I'm also happy to connect you with another great therapist in the area! My specialties include body image, food and weight issues, eating disorders, and anxiety.